Research

Retooling Our Comparisons of Addiction to Other Illnesses

Substance use disorders are among the most stigmatized conditions in the entire world. In this editorial, an internationally recognized addiction treatment and policy expert suggests how to talk about individuals with substance use disorder in a way that both legitimizes the need for medical care, and also recognizes the pain and suffering friends, family, and the community might experience.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

In international research studies, among a list of 18 of the most highly stigmatized social problems or conditions, illicit drug use disorder and alcohol use disorder (collectively known as substance use disorders) are ranked number one and number four, respectively. In part, it is the “collateral damage” caused by intoxicated and/or drug-seeking behaviors, as well as the belief that individuals with substance use disorder have at least some degree of personal responsibility for the condition, that lead to such common opinions. This can leave the general public feeling frightened and angry.

Thinking of substance use disorder as a medical condition benefiting from treatment, and in parallel, taking a public health rather than criminal justice approach, are two helpful ways of reducing this stigma. Indeed, some experts have extrapolated from comparing substance use disorder to chronic illnesses like asthma and diabetes to support a long-term recovery management perspective to suggest people ought to think of substance use disorders like other chronic illnesses more broadly.

Doing this, however, may invalidate or de-legitimize the harm substance use can do to someone’s friends, family, and society at large and thus ultimately this very important message about substance use disorder may fall flat, argues addiction expert Keith Humphreys. In this editorial, Humphreys outlines a rationale for why popular comparisons of substance use disorder to diabetes and asthma may miss the mark, and how we can address the problem of stigma while still realistically acknowledging the potential harm substance use disorders can cause.

HOW WAS THIS STUDY CONDUCTED?

This summary highlights an editorial by Keith Humphreys, an internationally recognized expert in addiction treatment and policy.

WHAT DID THIS STUDY FIND?

The editorial offers the following points regarding why comparing addiction to certain other chronic medical illnesses such as diabetes or asthma might not be a good fit:

Addictions have higher negative “externalities” compared to other medical disorders like diabetes and asthma to which they are often compared. Negative externalities means an individual or group making a decision does not have to pay the full cost of the decision. In other words, the substance use disorder may have consequences not only for the person with the disorder, but also for those with whom they interact, particularly family and friends.

Both of the following statements can be true: a) that negative feelings toward individuals with substance use disorder are understandable, and for some, even rational, and b) individuals with substance use disorder have a legitimate medical illness.

While a public health approach to addRessing substance use disorder is certainly a beneficial one, the criminal justice system can be helpful in addressing substance use disorder, particularly by protecting the public from intoxication-related harms, and serving as a conduit to treatment and recovery systems. At the same time, the criminal justice system can also do harm (e.g., using long-term prison sentences in response to relatively low-impact crimes). An evidence-based balance of public health and criminal justice approaches is needed.

The editorial recommends individuals in positions that can provide information to lay persons, policy makers, and other interested individuals – clinicians, researchers, etc. – recognize the pain and suffering individuals with substance use disorder can cause to those around them. Put another way, thinking of substance use disorder as a medical condition does not excuse the behavior, but rather can be used to help explain it, and programs and policies can be put into place to help reduce or otherwise address its societal harms.

Humphreys suggests chronic infectious disease, such as HIV/AIDS are more appropriate comparators in the public health arena than illnesses like asthma or diabetes. Specifically, HIV is a treatable medical condition that responds well to evidence-based care. At the same time, it is associated with higher negative externalities (e.g., potential effects on other individuals in the community) than illnesses like asthma or diabetes.

For example, from a public health perspective programs that facilitate condom dissemination and use, and access to sterile needles (e.g., needle exchanges) are needed to protect against the spread of HIV/AIDS and other infectious diseases. From a criminal justice perspective, there are laws in 24 states that require individuals who know they have HIV to disclose that status to sexual and needle-sharing partners. These laws exist to protect, in part, other individuals from the negative externalities of HIV.

WHY IS THIS STUDY IMPORTANT?

This editorial raised some key points worth considering in how we talk about substance use disorders. Ultimately the goal is to reduce the stigma of substance use disorder so people are willing to seek help as needed, and communities, states, and the federal government can provide the resources these individuals need to achieve and sustain remission. Recognizing substance use disorder as a good-prognosis medical condition that also has a very real and substantial impact on other people and the community at large may be an effective way to accomplish this.

LIMITATIONS

This is an editorial, and is limited by its reliance on the expertise of the author. As was the case here, though, the author or authors of editorials published in high-quality peer-reviewed journals are often experts in their respective areas, with well-established track records of rigorous research.

NEXT STEPS

The editorial was intended to raise ideas for consideration in how we message substance use disorder. Tests of these ideas, or hypotheses, would be good next steps. For example, a researcher might randomize lay individuals to receive different descriptions of individuals with substance use disorder, where one uses the description from this editorial (e.g., more akin to HIV/AIDS) and the other the description as a condition similar to asthma and diabetes. Then the person’s attitudes and beliefs about substance use disorder (or the individual with the disorder) can be measured.

BOTTOM LINE

For individuals & families seeking recovery: This editorial by an international expert in addiction treatment and policy suggests we would be well served to talk about substance use disorder as a legitimate medical condition, that can also have a substantial impact on other people and the community at large. Research is needed to test whether talking about substance use disorder in this way leads to more positive attitudes, and more effective policies and treatment access.

For scientists: This editorial by an international expert in addiction treatment and policy suggests we would be well served to talk about substance use disorder as a legitimate medical condition, that can also have a substantial impact on other people and the community at large. Research is needed to test whether talking about substance use disorder in this way leads to more positive attitudes, and more effective policies and treatment access.

For policy makers: This editorial by an international expert in addiction treatment and policy suggests we would be well served to talk about substance use disorder as a legitimate medical condition, that can also have a substantial impact on other people and the community at large. Research is needed to test whether talking about substance use disorder in this way leads to more positive attitudes, and more effective policies and treatment access.

For treatment professionals and treatment systems: This editorial by an international expert in addiction treatment and policy suggests we would be well served to talk about substance use disorder as a legitimate medical condition, that can also have a substantial impact on other people and the community at large. Research is needed to test whether talking about substance use disorder in this way leads to more positive attitudes, and more effective policies and treatment access.